Whether or not intensivists improve outcomes is debatable. Lost in this debate, however, is the fact that many surgical subspecialists are, in fact, well-trained critical care physicians. Obvious examples include trauma surgeons, burn surgeons, and cardiothoracic surgeons. The educational paradigms of these subspecialties, the inherent nature of the diseases, and the high acuity of the patients these surgical subspecialists treat demand that they be critical care physicians.
Critical care is intrinsic to cardiothoracic surgery. As defined by the American Board of Medical Specialties, a cardiothoracic surgeon “provides the operative, perioperative care and critical care of patients with acquired and congenital pathologic conditions within the chest.”1 The program requirements and curricula of thoracic surgery residencies accredited by the Accreditation Council for Graduate Medical Education demand an immersion into the critical care of cardiothoracic surgical patients; completion of these programs requires an attestation of resident competence by the program directors. The 2 largest professional societies of cardiothoracic surgery, the Society of Thoracic Surgery and the American Association for Thoracic Surgery, dedicate large portions of their annual meetings to critical care. The American Board of Thoracic Surgery specifically examines candidates on critical care as part of its determination of board certification. Cardiothoracic surgeons are, in fact, specialized critical care physicians.